Amended Statement of Changes in Beneficial Ownership (4/a)
March 26 2020 - 4:43PM
Edgar (US Regulatory)
FORM 4
[ ]
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
|
OMB APPROVAL
OMB Number:
3235-0287
Estimated average burden
hours per response...
0.5
|
|
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940
|
|
|
1. Name and Address of Reporting Person
*
Vapotherm Investors, LLC |
2. Issuer Name and Ticker or Trading Symbol
VAPOTHERM INC
[
VAPO
]
|
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director __X__ 10% Owner
_____ Officer (give title below) _____ Other (specify below)
|
|
(Last)
(First)
(Middle)
2540 NE MARTIN LUTHER KING JR. BLVD. |
3. Date of Earliest Transaction
(MM/DD/YYYY)
11/16/2018 |
|
(Street)
PORTLAND, OR 97212
(City)
(State)
(Zip)
|
4. If Amendment, Date Original Filed
(MM/DD/YYYY)
11/20/2018 |
6. Individual or Joint/Group Filing
(Check Applicable Line)
_X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
|
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
|
1.Title of Security
(Instr. 3)
|
2. Trans. Date
|
2A. Deemed Execution Date, if any
|
3. Trans. Code
(Instr. 8)
|
4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
|
5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
|
6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
|
7. Nature of Indirect Beneficial Ownership (Instr. 4)
|
|
Code
|
V
|
Amount
|
(A) or (D)
|
Price
|
| Common Stock | 11/16/2018 | | C | | 2042595 | A | (1) | 2042595 | D | |
| Common Stock | 11/16/2018 | | C | | 208752 | A | (2) | 2251347 | D | |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
|
1. Title of Derivate Security
(Instr. 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Trans. Date | 3A. Deemed Execution Date, if any | 4. Trans. Code
(Instr. 8) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5) | 6. Date Exercisable and Expiration Date | 7. Title and Amount of Securities Underlying Derivative Security
(Instr. 3 and 4) | 8. Price of Derivative Security
(Instr. 5) | 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) | 10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) | 11. Nature of Indirect Beneficial Ownership (Instr. 4) |
| Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
| Series A Convertible Preferred Stock | (1) | 11/16/2018 | | C | | | 227600 | (1) | (1) | Common Stock | 227600 | $0.00 | 0 | D | |
| Series B Convertible Preferred Stock | (1) | 11/16/2018 | | C | | | 75700 | (1) | (1) | Common Stock | 75700 | $0.00 | 0 | D | |
| Series C Convertible Preferred Stock | (1) | 11/16/2018 | | C | | | 849239 | (1) | (1) | Common Stock | 849239 | $0.00 | 0 | D | |
| Series D Convertible Preferred Stock | (1) | 11/16/2018 | | C | | | 890056 | (1) | (1) | Common Stock | 890056 | $0.00 | 0 | D | |
| Series D-1 Convertible Preferred Stock | (2) | 11/16/2018 | | C | | | 208752 | (2) | (2) | Common Stock | 208752 | $0.00 | 0 | D | |
| Warrant to Purchase Series A Convertible Preferred Stock (3) | $14.48 | 11/16/2018 | | J (3) | | | 42857 | 11/16/2018 | 9/7/2022 | Common Stock (3) | 42857 | $0.00 | 42857 | D | |
| Explanation of Responses: |
| (1) | Upon closing of the Issuer's initial public offering, each share of Series A Convertible Preferred Stock, Series B Convertible Preferred Stock, Series C Convertible Preferred Stock and Series D Convertible Preferred Stock automatically converted into one share of Common Stock without payment or further consideration. There was no expiration date for the Series A Convertible Preferred Stock, the Series B Convertible Preferred Stock, the Series C Convertible Preferred Stock or the Series D Convertible Preferred Stock. |
| (2) | Upon closing of the Issuer's initial public offering, each share of Series D-1 Convertible Preferred Stock automatically converted into 1.137 shares of Common Stock without payment or further consideration. There was no expiration date for the Series D-1 Convertible Preferred Stock. |
| (3) | Immediately prior to the closing of the Issuer's initial public offering, each outstanding Warrant to Purchase Series A Convertible Preferred Stock automatically converted into a Warrant to Purchase Common Stock. |
Reporting Owners
|
| Reporting Owner Name / Address | Relationships |
| Director | 10% Owner | Officer | Other |
Vapotherm Investors, LLC
2540 NE MARTIN LUTHER KING JR. BLVD.
PORTLAND, OR 97212 |
| X |
|
|
Signatures
|
| /s/ Anthony Ten Haagen, as Attorney-In-Fact | | 3/26/2020 |
| **Signature of Reporting Person | Date |
Vapotherm (NYSE:VAPO)
Historical Stock Chart
From Mar 2024 to Apr 2024
Vapotherm (NYSE:VAPO)
Historical Stock Chart
From Apr 2023 to Apr 2024
